In many patients, the first symptom of coronary artery disease or CAD is a heart attack (myocardial infarction) or sudden death, with no preceding chest pain as a warning. For this reason, doctors perform screening tests to detect signs of CAD before serious medical events occur. The tests are designed to detect plaque before a coronary artery becomes completely blocked. Screening tests are of particular importance for patients with risk factors for CAD.
The first step to getting a heart disease diagnosis is receiving an exam from a doctor. The doctor will check your pulse, listen to your heartbeat for irregularities, run various blood labs, and check your blood pressure. The patients blood pressure is checked most often using a cuff style monitor, also known as a sphygmomanometer, which is an inflatable cuff wrapped around the upper bicep to take a reading of the systolic and diastolic pressures made by the beating of the heart. It is important to have an understanding when it comes to your blood pressure because, if for whatever reason, it is elevated you could be at risk for stroke, hypertension, or diabetes. Knowing your pulse is also very important, your pulse is how many times your heart beats per minute, or bpm. Doctors will often use a stethoscope, or even their own two fingers applied to pulse points on the body, to count the beats of the heart.
example of a stethoscope compliments of google images
example of a sphygmomanometer compliments of google images
Some target values to aim for are:
- A normal pulse for an adult is 60-100 beats per minute.
- For children pulse should be split depending on their age
Newborns 0-1 month old
70-190 beats per min.
Infants 1-11 months
80-160 beats per min.
Children 1-2 yrs
80-130 beats per min.
Children 3-4 yrs
80-120 beats per min.
Children 5-6 yrs
75-115 beats per min.
Children 7-9 yrs
70-110 beats per min.
- A normal blood pressure for an adult is equal to or less than 120/80.
-Prehypertensive blood pressure would be 139/89 and high blood pressure would be 140/90.
Whether you prefer it EKG or ECG, an electrocardiogram is essentially a “glimpse” of the heart’s electrical activity. Sometimes it is also known as Holter Monitoring, Ambulatory ECG, or Ambulatory EKG. An EKG assists doctors in determining what state your heart is in and how to forgo treatment if it is needed. It’s important to remember that an EKG is beneficial to tracking your health and is a routine and noninvasive practice. ECG machines can be preformed during routine physical examinations, cardiac exercise stress tests, or if a patient is experiencing any of the following symptoms chest pain, shortness of breath, dizziness, or fainting. Electrocardiograms are used to detect the underlying rate and rhythm of the heart. An ECG can also detect damage to various parts of the heart muscle or impaired blood flow.
In an electrocardiogram, electrodes are applied to the arms, legs, and chest, as shown by the image below. The patient lies still for a few minutes while the electrodes monitor the activities of the heart.
courtesy of google images
Chest X-Ray
A chest x-ray is a commonly used tool to explore the chest cavity for diagnostic as well as routine measures. Some of the main visible structures that appear on the x-ray are the bone structures, heart, lungs, large arteries, ribs, and even some major blood vessels. Chest x-rays are used mainly for lung disorders, heart failure, and bone examinations for fractures.
A typical exam is preformed by a radiologists or technician in the radiology department. Two views are taken, one in which the x-rays pass from the chest to the back and then another from one side to the other (lateral view).
In order to prepare for a chest x-ray you must wear a hospital gown and remove all jewelry, there is no pain but there may be slight discomfort based on how cold the film plate is that they place on you.
After taking several x-rays, the results are given to your doctor who will assess them with you. Doctors will preform a chest x-ray if you have a persistent cough, chest injury or pain, coughing up blood, or are having difficulty breathing. Overall, a chest x-ray is a good preventative measure that should be considered for part of your annual physical.
A cardiac stress test is normally performed to analyze the patient’s cardiac and respiratory function(s). The stress test can help a physician in the diagnosis of coronary heart disease or determining the severity of coronary heart disease.
The make up of this thorough examination can be anything from cardiac output to respiratory efforts. Most commonly, an exercise stress test is performed. It can also be referred to as an exercise electrocardiogram, a treadmill test, a graded exercise test, an exercise tolerance test or a stress ECG.
Typically the cardiologist will attach multiple electrodes to specific parts of the chest cavity to better analyze the specific cardiac output of various parts of the heart. Next, the patient begins walking on a treadmill or pedaling on a stationary bike which progressively increases in speed and incline over time. If a patient is unable to exercise, a drug will be administered that has a similar effect on the body as exercise.
Many measurements are obtained by the electrodes which provide the cardiologist with key indicators regarding the cardiac and pulmonary systems. Changes in the electrocardiogram patterns and blood pressure levels can indicate when the heart is not getting enough oxygen.
The head-up tilt table test is used to help find the cause of unexplained fainting, also know as syncope. The video below is what a person should expect when doing a tilt table test.
During the test, there will be sticky patches attached to wires (electrodes) that will be placed on the patients chest, legs, and arms. The patches will be connected to an electrocardiogram (ECG) which will measure the heart rate. There will also be a sphygmomanometer (blood pressure cuff) attached to the patient to measure blood pressure, and an IV will be placed into the patients arm or back of the hand in order to take a blood sample. This IV can also deliver medications if needed.
Results for this test should be given to the patient by the end of the day. If the patient faints or has any other symptoms during the test, then there may be a condition that causes abnormal changes in the patients blood pressure or heart rate. If the patient does not faint, it is possible that he/she might need to have more tests.
An echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image and involves no radiation exposure. This test is performed to evaluate the valves and chambers of the heart in a noninvasive way. Below are pictures of what a normal and abnormal echocardiogram look like.
The following websites explain the procedure in more detail:A trained sonographer uses an instrument called a transducer that transmits high-frequency sound waves which will be placed on the patient's ribs near the breast bone and directed toward the heart. The Doppler probe records the motion of the blood through the heart. This test can be used to assess the overall function of the heart,determine the presence of many types of heart disease, follow the progress of valve disease over time, and evaluate the effectiveness of medical or surgical treatments. If there is an abnormal echocardiogram, the results could range from minor to more serious. There will be further evaluation and tests to determine the risk of the abnormality.
Cardiac catheterization -- also called a coronary angiogram -- means running a plastic catheter into your heart through the patients blood vessel either in the leg or arm. This is an invasive procedure. It's done to help doctors see what's going on in the heart, and whether they need to operate. The link below shows a video where the whole procedure is explained: http://www.dnatube.com/video/9238/Cardiac-catheterization-or-cardiac-cath
The patient will be given a mild sedative before the test to help with relaxation. The catheter is inserted through the IV and into the patients blood vessel where it is carefully threaded into the heart using an x-ray. Once the catheter is in its proper place, the doctor may do one of five things:
Collect blood samples from the heart
Measure pressure and blood flow in the heart's chambers and in the large arteries around the heart
Measure the oxygen in different parts of your heart
Examine the arteries of the heart with an x-ray technique called fluoroscopy (which gives immediate, "real-time" pictures of the x-ray images on a screen and provides a permanent record of the procedure)
Perform a biopsy on the heart muscle
The procedure can identify heart defects or disease like coronary artery disease, valve problems, ventricular aneurysms, and/or heart enlargement.
Cardiac catheterization is also used as part of some procedures to treat heart disease. These procedures include:
Angioplasty with or without stent placement. Angioplasty involves temporarily inserting and expanding a tiny balloon at the site of your blockage to help widen a narrowed artery. Angioplasty is usually combined with implantation of a small metal coil called a stent in the clogged artery to help prop it open and decrease the chance of it narrowing again (restenosis).
Closure of holes in the heart. Some congenital heart defects involving holes in the heart can be treated by threading a catheter to the hole to close it, rather than having open-heart surgery.
Repair or replace leaky heart valves. Using cardiac catheterization, doctors can repair or replace a leaking or narrowed heart valve. Sometimes, doctors will use catheterization to fix a leaking replacement valve.
Balloon valvuloplasty. This procedure can open narrowed heart valves by threading a balloon-tipped catheter to the part of your heart valve that's narrowed and inflating it.
Heart arrhythmia treatment (ablation). Ablation is a procedure that scars your heart tissue to re-route the electrical signals that cause your heart to beat. Radiofrequency energy (heat), a laser or nitrous oxide (extreme cold) is applied through the catheter tip to the abnormal heart tissue. The energy destroys (ablates) the abnormal heart tissue causing the heart rhythm disorder.
Blood clot treatment (thrombectomy). In this procedure, your doctor inserts a catheter into an artery and guides it to a blood clot in a blood vessel. Attachments on the catheter remove the blood clot.
Electrophysiology (the EP test) takes measurements of your heart rhythm -- recording the electrical activity and pathways of your heart.
This test takes place in a hospital and is performed by trained staff that includes a cardiologist, nurses, and technicians. This test helps determine the cause of a patients heart rhythm disturbance. It will also assist on what the best treatment would be. During the study, the doctor will reproduce the abnormal heart rhythm and then may give the patient different medications to see which one controls it best. The doctor may also use it to determine the best procedure or device to treat the heart rhythm.
There are significant risks from this procedure. Most important, some abnormal heart rhythms (arrhythmia) can be life-threatening, and your doctors will purposefully cause you to go through a few extra episodes of arrhythmia during the testing. If your doctors recommend electrophysiologic testing, they feel that this is a risk worth taking because it will allow them to take better care of you in the future. Because you are right in the lab and attached to a monitor while you undergo the rhythm changes, it is easy for them to treat you should your arrhythmia occur and cause you symptoms.
An EP test may be done to:
test the function of your hearts electrical system
pinpoint a known abnormal heart rhythm (arrhythmia) that is starting in the heart, and help decide the best therapy for it
determine whether you are at risk for future heart events, especially sudden cardiac death
see if medicine is controlling an abnormal heart rhythm
see whether you need a pacemaker or implantable cardioverter-defibrillator (ICD)
The picture above shows the flow of blood as it is pumped through the heart.
The purpose of CT (computed tomography) heart scan is to provide a visualization of the heart, specifically its anatomy and circulation using computer technology and x-ray imaging. Calcium-score screening heart scan, coronary CT angiography, and Total body CT scan are three types of CT scans that are used in diagnosing heart disease.
Preparation before an exam is crucial to the validity of the results, blood work and lab tests may be required before the examination can take place. It is also important to avoid caffeine which can be found in certain beverages and medications (ex. diet pills).
CT heart scans measures the amount of coronary calcium within the patient and the computer generates a computer "score" using the findings. This test is designed to identify the amount of calcium deposits that can be found in atherosclerotic plaque in the arteries. The calcium score is a useful indicator in predicting the probability of the patient experiencing cardiac events such as a heart attack.
Figure A is an illustration of the outside of the heart. The arrow shows the point of view of the cardiac CT image. The inset image shows the position of the heart in the body. Figure B is a cardiac CT image showing the coronary arteries on the surface of the heart. This is a picture of the whole heart put together by a computer.
With every test there are pros. and cons. that the patient should be aware of. Some of the pros. that this test possess are it's noninvasive technique, the fact that it is not time consuming, and no radiation remains in the patient's body. The cons. for this test include inability to be used on pregnant women and a slight risk of acquiring cancer due to the radiation.'
Myocardial biopsy, also known as a heart biopsy is an invasive procedure that uses a bioptome ( a small catheter with a grasping device on the end) to remove a small amount of heart muscle tissue that a laboratory can further analysis. Myocardial biopsies are useful for determining organ rejection after a heart transplant and in determining the presence of myocarditis (inflammation of the muscles of the heart) and other disorders of the heart.
This procedure is performed in an outpatient setting and the patient can wear normal clothing. Food and fluid restriction 6-8 hours before the test is recommended and any nutrient supplements or medications that the patient is taking should be brought to the attention of the doctor.
Abnormal values are indicators of myocarditis, amyloidosis, or transplant rejection. Some of the risks of a heart biopsies include: blood clots, infections, cardiac arrythmias, bleeding from the biopsy site.
MRIs are a noninvasive technique that uses magnets and radio frequency to generate an image of patient's internal structures (no X-ray exposure is involved). This technique is useful in providing an image of the heart as it is beating and show patterns of blood circulation. The purpose of MRI is to provide doctors with an inside look at the anatomy and function of the structures of the thoracic (chest) region which includes organs such as the heart, lungs, and vessels. Diseases such as congenital heart disease, cardiac tumors and heart valve disease can also be detected using an MRI. You can eat as usual unless you are to take a sedative prior to the MRI, in this case it is recommended that the patient not eat or drink anything 4-6 hours before the test and inform the technician if dialysis is being received. Patients who are pregnant or patients with inner ear implants, recently placed artificial joints or brain aneurysm clips may not be able to have an MRI due to it's interference with metallic fields.
Before undergoing tests a doctor can first listen to your heart by placing a stethoscope on your chest to check for the sounds characteristic of pericarditis, which are made when the pericardial layers rub against each other. This characteristic noise is called a pericardial rub. Tests done to determine if pericariocentesis is neccessary include a ECG, chest X-ray, echocardiogram, CT, or MRI. Pericardiocentesis, also known as a pericardial tap is an invasive procedure involving the removal of fluid from the sac around the heart, its done to find the cause of fluid buildup around the heart and to relieve pressure on the heart.The fluid that is removed is useful in determining the presence or absence of infection and cancer. Pericardiocentesis can also be used as a method of treatment too, it can be used to relieve shortness of breath due to accumulation of fluid around the heart. On the day of this procedure, no special clothing is required and all valuables should be left at home. Bring any previous tests results and medications.
Normal values include:
No bacteria,red blood cells , or cancer cells are present in the pericardial fluid.
No white blood cells are in pericardial fluid. WBC count should be <300 mm^3
The pericardial fluid is clear or pale yellow.
Glucose 70-100 g/dL
There is less than 50 mL (2 fl oz) of fluid in the pericardial sac.
Protein <4.0 g/L
Volume Minimal, usually +20 mL
The risks of this procedure include: heart attack, puncturing of the heart, and production of an irregular heart rhythm
In many patients, the first symptom of coronary artery disease or CAD is a heart attack (myocardial infarction) or sudden death, with no preceding chest pain as a warning. For this reason, doctors perform screening tests to detect signs of CAD before serious medical events occur. The tests are designed to detect plaque before a coronary artery becomes completely blocked. Screening tests are of particular importance for patients with risk factors for CAD.
More information about CAD can be found below:
http://www.medicinenet.com/coronary_artery_disease_screening_tests_cad/article.htm
http://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/basics/definition/con-20032038
Heart Disease Diagnosis
The first step to getting a heart disease diagnosis is receiving an exam from a doctor. The doctor will check your pulse, listen to your heartbeat for irregularities, run various blood labs, and check your blood pressure. The patients blood pressure is checked most often using a cuff style monitor, also known as a sphygmomanometer, which is an inflatable cuff wrapped around the upper bicep to take a reading of the systolic and diastolic pressures made by the beating of the heart. It is important to have an understanding when it comes to your blood pressure because, if for whatever reason, it is elevated you could be at risk for stroke, hypertension, or diabetes. Knowing your pulse is also very important, your pulse is how many times your heart beats per minute, or bpm. Doctors will often use a stethoscope, or even their own two fingers applied to pulse points on the body, to count the beats of the heart.Some target values to aim for are:
- A normal pulse for an adult is 60-100 beats per minute.
- For children pulse should be split depending on their age
- A normal blood pressure for an adult is equal to or less than 120/80.
-Prehypertensive blood pressure would be 139/89 and high blood pressure would be 140/90.
The following websites describe in more detail the tests that the doctors will perform and how you can preform some on your own:
http://www.texasheartinstitute.org/HIC/Topics/Diag/
http://my.clevelandclinic.org/heart/services/tests/exam.aspx
http://my.clevelandclinic.org/heart/prevention/exercise/pulsethr.aspx
http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm
Labs/Tests:
Electrocardiogram (EKG or ECG)
Whether you prefer it EKG or ECG, an electrocardiogram is essentially a “glimpse” of the heart’s electrical activity. Sometimes it is also known as Holter Monitoring, Ambulatory ECG, or Ambulatory EKG. An EKG assists doctors in determining what state your heart is in and how to forgo treatment if it is needed. It’s important to remember that an EKG is beneficial to tracking your health and is a routine and noninvasive practice. ECG machines can be preformed during routine physical examinations, cardiac exercise stress tests, or if a patient is experiencing any of the following symptoms chest pain, shortness of breath, dizziness, or fainting. Electrocardiograms are used to detect the underlying rate and rhythm of the heart. An ECG can also detect damage to various parts of the heart muscle or impaired blood flow.More about EKG/ ECGs can be found at the following links:
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=68&TopicID=600
http://www.nhlbi.nih.gov/health/health-topics/topics/ekg/
http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Electrocardiogram-ECG-or-EKG_UCM_309050_Article.jsp#
In an electrocardiogram, electrodes are applied to the arms, legs, and chest, as shown by the image below. The patient lies still for a few minutes while the electrodes monitor the activities of the heart.
Chest X-Ray
A chest x-ray is a commonly used tool to explore the chest cavity for diagnostic as well as routine measures. Some of the main visible structures that appear on the x-ray are the bone structures, heart, lungs, large arteries, ribs, and even some major blood vessels. Chest x-rays are used mainly for lung disorders, heart failure, and bone examinations for fractures.A typical exam is preformed by a radiologists or technician in the radiology department. Two views are taken, one in which the x-rays pass from the chest to the back and then another from one side to the other (lateral view).
In order to prepare for a chest x-ray you must wear a hospital gown and remove all jewelry, there is no pain but there may be slight discomfort based on how cold the film plate is that they place on you.
After taking several x-rays, the results are given to your doctor who will assess them with you. Doctors will preform a chest x-ray if you have a persistent cough, chest injury or pain, coughing up blood, or are having difficulty breathing. Overall, a chest x-ray is a good preventative measure that should be considered for part of your annual physical.
More information can be found below:
http://my.clevelandclinic.org/services/x-ray/hic_chest_x-ray.aspx
http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm
The following website shows an image of a normal chest x-ray compared to an abnormal chest x-ray:
http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/cxr/atlas/cxratlas_f.htm
http://www.mayoclinic.org/tests-procedures/chest-x-rays/multimedia/chest-x-ray/img-20006961
Stress Test
A cardiac stress test is normally performed to analyze the patient’s cardiac and respiratory function(s). The stress test can help a physician in the diagnosis of coronary heart disease or determining the severity of coronary heart disease.The make up of this thorough examination can be anything from cardiac output to respiratory efforts. Most commonly, an exercise stress test is performed. It can also be referred to as an exercise electrocardiogram, a treadmill test, a graded exercise test, an exercise tolerance test or a stress ECG.
Typically the cardiologist will attach multiple electrodes to specific parts of the chest cavity to better analyze the specific cardiac output of various parts of the heart. Next, the patient begins walking on a treadmill or pedaling on a stationary bike which progressively increases in speed and incline over time. If a patient is unable to exercise, a drug will be administered that has a similar effect on the body as exercise.
Many measurements are obtained by the electrodes which provide the cardiologist with key indicators regarding the cardiac and pulmonary systems. Changes in the electrocardiogram patterns and blood pressure levels can indicate when the heart is not getting enough oxygen.
Here are some great descriptions of the test, including how to prepare for a stress test:
http://www.texasheartinstitute.org/HIC/Topics/Diag/distress.cfm
http://www.nlm.nih.gov/medlineplus/ency/article/003878.htm
http://cvi.med.nyu.edu/patients/treatments-technologies-surgeries/cardiac-stress-test
http://www.nhlbi.nih.gov/health/health-topics/topics/stress/
Tilt Table Test
The head-up tilt table test is used to help find the cause of unexplained fainting, also know as syncope. The video below is what a person should expect when doing a tilt table test.http://heart.emedtv.com/common-heart-conditions,-tests,-and-procedures-video/tilt-table-test-video.html
During the test, there will be sticky patches attached to wires (electrodes) that will be placed on the patients chest, legs, and arms. The patches will be connected to an electrocardiogram (ECG) which will measure the heart rate. There will also be a sphygmomanometer (blood pressure cuff) attached to the patient to measure blood pressure, and an IV will be placed into the patients arm or back of the hand in order to take a blood sample. This IV can also deliver medications if needed.
Results for this test should be given to the patient by the end of the day. If the patient faints or has any other symptoms during the test, then there may be a condition that causes abnormal changes in the patients blood pressure or heart rate. If the patient does not faint, it is possible that he/she might need to have more tests.
For more information go to the sites below.
http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Tilt-Table-Test_UCM_446441_Article.jsp
http://www.medicinenet.com/tilt-table_test/article.htm
Echocardiogram
An echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image and involves no radiation exposure. This test is performed to evaluate the valves and chambers of the heart in a noninvasive way. Below are pictures of what a normal and abnormal echocardiogram look like.http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm
The following websites explain the procedure in more detail:A trained sonographer uses an instrument called a transducer that transmits high-frequency sound waves which will be placed on the patient's ribs near the breast bone and directed toward the heart. The Doppler probe records the motion of the blood through the heart. This test can be used to assess the overall function of the heart,determine the presence of many types of heart disease, follow the progress of valve disease over time, and evaluate the effectiveness of medical or surgical treatments. If there is an abnormal echocardiogram, the results could range from minor to more serious. There will be further evaluation and tests to determine the risk of the abnormality.
http://www.everydayhealth.com/echocardiogram/
http://my.clevelandclinic.org/heart/services/tests/ultrasound/echo.aspx
http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm
Cardiac Catheterization
Cardiac catheterization -- also called a coronary angiogram -- means running a plastic catheter into your heart through the patients blood vessel either in the leg or arm. This is an invasive procedure. It's done to help doctors see what's going on in the heart, and whether they need to operate.The link below shows a video where the whole procedure is explained:
http://www.dnatube.com/video/9238/Cardiac-catheterization-or-cardiac-cath
The patient will be given a mild sedative before the test to help with relaxation. The catheter is inserted through the IV and into the patients blood vessel where it is carefully threaded into the heart using an x-ray. Once the catheter is in its proper place, the doctor may do one of five things:
- Collect blood samples from the heart
- Measure pressure and blood flow in the heart's chambers and in the large arteries around the heart
- Measure the oxygen in different parts of your heart
- Examine the arteries of the heart with an x-ray technique called fluoroscopy (which gives immediate, "real-time" pictures of the x-ray images on a screen and provides a permanent record of the procedure)
- Perform a biopsy on the heart muscle
The procedure can identify heart defects or disease like coronary artery disease, valve problems, ventricular aneurysms, and/or heart enlargement.Here is another video that describes what to expect when going in to have a cardiac catheter:
http://www.youtube.com/watch?v=Ig7jQzEGpFg
Cardiac catheterization is also used as part of some procedures to treat heart disease. These procedures include:
Helpful Links:
http://www.metrohealth.org/body.cfm?id=266
http://www.nlm.nih.gov/medlineplus/ency/article/003419.htm
http://www.nhlbi.nih.gov/health/health-topics/topics/cath/
http://www.mayoclinic.com/health/cardiac-catheterization/MY00218
Electrophysiology Test
Electrophysiology (the EP test) takes measurements of your heart rhythm -- recording the electrical activity and pathways of your heart.This test takes place in a hospital and is performed by trained staff that includes a cardiologist, nurses, and technicians. This test helps determine the cause of a patients heart rhythm disturbance. It will also assist on what the best treatment would be. During the study, the doctor will reproduce the abnormal heart rhythm and then may give the patient different medications to see which one controls it best. The doctor may also use it to determine the best procedure or device to treat the heart rhythm.
There are significant risks from this procedure. Most important, some abnormal heart rhythms (arrhythmia) can be life-threatening, and your doctors will purposefully cause you to go through a few extra episodes of arrhythmia during the testing. If your doctors recommend electrophysiologic testing, they feel that this is a risk worth taking because it will allow them to take better care of you in the future. Because you are right in the lab and attached to a monitor while you undergo the rhythm changes, it is easy for them to treat you should your arrhythmia occur and cause you symptoms.
An EP test may be done to:
Helpful Links:
http://www.health.harvard.edu/diagnostic-tests/electrophysiological-testing-of-the-heart.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003867.htm
http://www.heart.org/HEARTORG/Conditions/Arrhythmia/SymptomsDiagnosisMonitoringofArrhythmia/Electrophysiology-Studies-EPS_UCM_447319_Article.jsp#.VmDxjXarSM8
CT Heart Scan
The purpose of CT (computed tomography) heart scan is to provide a visualization of the heart, specifically its anatomy and circulation using computer technology and x-ray imaging. Calcium-score screening heart scan, coronary CT angiography, and Total body CT scan are three types of CT scans that are used in diagnosing heart disease.Preparation before an exam is crucial to the validity of the results, blood work and lab tests may be required before the examination can take place. It is also important to avoid caffeine which can be found in certain beverages and medications (ex. diet pills).
CT heart scans measures the amount of coronary calcium within the patient and the computer generates a computer "score" using the findings. This test is designed to identify the amount of calcium deposits that can be found in atherosclerotic plaque in the arteries. The calcium score is a useful indicator in predicting the probability of the patient experiencing cardiac events such as a heart attack.
With every test there are pros. and cons. that the patient should be aware of. Some of the pros. that this test possess are it's noninvasive technique, the fact that it is not time consuming, and no radiation remains in the patient's body. The cons. for this test include inability to be used on pregnant women and a slight risk of acquiring cancer due to the radiation.'
Helpful Links:
http://www.princetonlongevitycenter.com/CTangiography.shtml?gclid=COXhx83P3qwCFS4DQAodzS1Opw
http://www.nlm.nih.gov/medlineplus/ency/article/007344.htm
http://www.mayoclinic.com/health/heart-scan/MY00327
Myocardial Biopsy
Myocardial biopsy, also known as a heart biopsy is an invasive procedure that uses a bioptome ( a small catheter with a grasping device on the end) to remove a small amount of heart muscle tissue that a laboratory can further analysis. Myocardial biopsies are useful for determining organ rejection after a heart transplant and in determining the presence of myocarditis (inflammation of the muscles of the heart) and other disorders of the heart.This procedure is performed in an outpatient setting and the patient can wear normal clothing. Food and fluid restriction 6-8 hours before the test is recommended and any nutrient supplements or medications that the patient is taking should be brought to the attention of the doctor.
Abnormal values are indicators of myocarditis, amyloidosis, or transplant rejection.
Some of the risks of a heart biopsies include: blood clots, infections, cardiac arrythmias, bleeding from the biopsy site.
http://www.webmd.com/heart-disease/guide/myocardial-biopsy
http://www.nlm.nih.gov/medlineplus/ency/article/003873.htm
http://my.clevelandclinic.org/heart/services/tests/invasive/myobx.aspx
Heart MRI
MRIs are a noninvasive technique that uses magnets and radio frequency to generate an image of patient's internal structures (no X-ray exposure is involved). This technique is useful in providing an image of the heart as it is beating and show patterns of blood circulation.The purpose of MRI is to provide doctors with an inside look at the anatomy and function of the structures of the thoracic (chest) region which includes organs such as the heart, lungs, and vessels. Diseases such as congenital heart disease, cardiac tumors and heart valve disease can also be detected using an MRI.
You can eat as usual unless you are to take a sedative prior to the MRI, in this case it is recommended that the patient not eat or drink anything 4-6 hours before the test and inform the technician if dialysis is being received. Patients who are pregnant or patients with inner ear implants, recently placed artificial joints or brain aneurysm clips may not be able to have an MRI due to it's interference with metallic fields.
Helpful Links:
http://www.nlm.nih.gov/medlineplus/ency/article/003795.htm
http://www.radiologyinfo.org/en/info.cfm?pg=cardiacmr
http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Magnetic-Resonance-Imaging-MRI_UCM_441632_Article.jsp#.VlvdLGSrQy4
Pericardiocentesis
Before undergoing tests a doctor can first listen to your heart by placing a stethoscope on your chest to check for the sounds characteristic of pericarditis, which are made when the pericardial layers rub against each other. This characteristic noise is called a pericardial rub. Tests done to determine if pericariocentesis is neccessary include a ECG, chest X-ray, echocardiogram, CT, or MRI.Pericardiocentesis, also known as a pericardial tap is an invasive procedure involving the removal of fluid from the sac around the heart, its done to find the cause of fluid buildup around the heart and to relieve pressure on the heart.The fluid that is removed is useful in determining the presence or absence of infection and cancer. Pericardiocentesis can also be used as a method of treatment too, it can be used to relieve shortness of breath due to accumulation of fluid around the heart.
On the day of this procedure, no special clothing is required and all valuables should be left at home. Bring any previous tests results and medications.
Normal values include:
The risks of this procedure include: heart attack, puncturing of the heart, and production of an irregular heart rhythm
Helpful Links:
http://www.webmd.com/heart-disease/pericardial-tap?page=3
http://www.mayoclinic.com/health/pericarditis/DS00505/DSECTION=tests-and-diagnosis
http://medical-dictionary.thefreedictionary.com/pericardiocentesis (lab values)
http://www.webmd.com/heart-disease/guide/pericardiocentesis